Trinity: The Problem with Allowances

Trinity Hospital in Muona

         The reputation of Trinity as a well-kept place precedes my visit.  It is a Catholic hospital and a paying one. Because of that there are fewer patients.  In fact the Female Ward is closed and the Male Ward is being used as both a Female and Male Ward. The place is clean and the Pediatric Ward is less depressing of all the pediatric wards I have seen in Africa.  There is also a TB Isolation Ward and a nursing school. The ART Clinic is in a new building and the waiting room was full that day, it is the only clinic that is free with the exception of having to pay for the lab test for CD4 counts, the enumeration of the immune cells.

The ART Clinic in Trinity

       

          The consultation rooms are very spacious but there is the absence of an exam bed.  The Medical Assistant had two patients in his room at one time with absolutely no regard to privacy and patient confidentiality.

When there was a lull he asked my team, “When is the next ART training?

            “Didn’t you already have one?” My team member asked.

            “But I’m looking for one that will pay me a higher allowance.”

            “Why do you go for training?” I asked.

            “To get training and allowance.”

“Fair enough. “I thought to myself

I asked,” What if there is no allowance, would you still go?”

He thought for a moment,” If food were provided, I’d go. But if there were no food and allowance, I would not go.” He added,” I’m poor.”

I am not very clear on the history of allowances.  It was said that years ago, IMF stipulates that in order for a developing country to get aids from IMF in the health sector, the government needs to maintain a low wage for the healthcare workers.  Allowances are given to them for training as a form of supplement to their meager earnings.  As a result there is an unhealthy culture of expectation of being paid allowances to be educated so much so that looking for training courses becomes synonymous with getting paid at a higher level.  Allowance becomes a bargaining chip even when a meeting is called, the mentality of “what would I get in return for showing up” permeates the whole system.  A meeting called close to lunch hour conjures up “a free lunch”.  It could also be used as a form of blackmail; if I were not to be given an allowance, I’d not show up.  Years ago when I was in rural Tanzania, a senior person was away so much on various different training programs in Dar es Salaam, she was never around to do her real work to the extent that an expat was doing all her work and reports for her.

Allowances aside, this medical officer we mentored this morning was so slip-shod with his patients that he hardly spoke to them, burying his face to fill out the forms, the so-called master cards, handing the form back to the patients with their medication refills and mentioning the next appointment date. There was a woman complaining of a lump in her right groin, he probed verbally but never once asked to see her swelling. He failed to listen to the lungs of a man with a persistent cough for a month. It was as though he was afraid to touch his patients.  Seeing patients seemed a very tedious and mundane job for him; somewhere along the way he had lost his passion for them.  My team member was somewhat gentle with him in his final critique but I did not mince my words and told him exactly what I thought.  To be fair, there are many medical assistants and nurses who are really good and kind to their patients and often reach out to them in personal and humanistic ways.

            Yesterday there was a black-out.  The women sat on the dirt patiently outside the mill with their bags and buckets of corn waiting for the electricity to come back.  When it became dark and the electricity failed to turn on, they marched back 

home in droves, singing. This morning they marched back, they no longer pound their corn like they used to. There was a scuffle at the entrance of the mill; it had become more urgent to get their corn milled after all the waiting, they had lost their patience.

We traveled to Mesengere to pick up another member of our team. There the nurse mid-wife immediately came to me to ask for a ride for a primigravida with cephalopelvic disproportion to Trinity.  Having sent their ambulance to fetch fuel at Nsanje, three to four hours away, they did not think of transferring her earlier to Trinity which was half an hour away.  We emptied our cruiser and folded up the seats, placed a mattress in it and back-tracked to Trinity for her emergency C-section. Our driver said we could only transport patients towards where we would be traveling and not back-tracking but I made the decision to do just that, I refused to have a potential loss of life on my conscience, even if this delayed our departure from the East Bank. 

It was dark when we reached Nsanje. Over the Shire River the red ball of an almost full moon hung watchfully.